Where to place an IV.....

[mobey]

and as for a sublingual injection?? I've never heard of that. Well except in the dentists office when he is poking me with needles in my gums but never under my tongue.

And all I can muster in my head to say to flaming is this....WTF DUDE!!!! I'm pretty sure a tube in thier butt is about as effective as giving meds down a tube in thier lungs...

SL injections are used in extreme presentations of near death anaphylaxis being attended too by BLS crews in the prairie provinces. BLS can do IM injections but not IV.

The theory is, a patient who is shut down peripherally will respond to SL injection as it is more central.

I have no idea if it is supported by science, but hey... in that position, I would give it a shot.

Tongue in cheek here: Per rectal is actually a well studied and acceptible drug route. I used to use Midaz per rectal in Peds for seizures back in the day.

Tubing the rectum with an ET tube though.... That is just stupid. A much smaller tubing is more appropriate eg; Suction, cutoff nasal cannula, foley, etc

[nypamedic43]

Thanks mobey I know that sometimes what is not familiar to me may very well be commonplace elsewhere.

I have heard of rectal valium for young patients that have epilepsy and whom go into status seizure on a regular basis. But it isnt through an ET tube and parents or guardians are versed in using it rectally. We have a 3 yr old in our area that is well known to all of us for this and she usually completely bypasses the local hospitals if we can break the status seizure. If not, she goes to the local ED and is then transferred out when stable enough to travel. With our new protocol, we would have to use the Midaz with her now.

I wish we could get intranasal. Maybe in time it will happen.

[Just Plain Ruff]

Tubing the rectum with an ET tube though.... That is just stupid. A much smaller tubing is more appropriate eg; Suction, cutoff nasal cannula, foley, etc

I tend to second the stupidity of tubing a rectum with a ET Tube for drug administration

Just stick the syringe in the butt hole and push the plunger. It works better than anything you can jury rig up. Just make sure to pull the entire syringe out.

Injecting directly into the vein is called mainlining. It's what heroin addicts do. In every place I've worked it has been frowned upon or just outright not allowed. In one place I think it was even illegal.

As for sublingual injections, well, that would just be painful. Would you open your mouth for someone wanting to stick a needle under your tongue?

I have "mainlined" pateints before.

Patient refuses IV but needs an IV injection. Patient allowed the injection in the vein. Didn't bat an eye doing this.

Patient felt better after the injection that he allowed the IV and fluid administration.

[DFIB]

Injecting directly into the vein is called mainlining. It's what heroin addicts do. In every place I've worked it has been frowned upon or just outright not allowed. In one place I think it was even illegal.

I am still curious as to why your protocols are against IV injections.

[mobey]

I am still curious as to why your protocols are against IV injections.

I realize you were not asking me, but I am in a similar situation.

There is not a specific note in the protocols that say "No mainlining", however if I were to "mainline" a drug I could see 3 things happening:

1) Co-workers would poke fun at me for weeks on end

2) Our PCR Audit committee would question my conduct

(And if I tried to defend myself)

3) My employer would offer me remedial training on proper I.V. medication administration.

Start mainlining drugs and you WILL have a wreck! Only a matter of time before some bonehead tries to do it with D50W or Calcium and does some real damage.

[Just Plain Ruff]

I realize you were not asking me, but I am in a similar situation.

There is not a specific note in the protocols that say "No mainlining", however if I were to "mainline" a drug I could see 3 things happening:

1) Co-workers would poke fun at me for weeks on end

2) Our PCR Audit committee would question my conduct

(And if I tried to defend myself)

3) My employer would offer me remedial training on proper I.V. medication administration.

Start mainlining drugs and you WILL have a wreck! Only a matter of time before some bonehead tries to do it with D50W or Calcium and does some real damage.

Actually Mobey, I witnessed a physician giving an amp of d50 via a AC injection minus the IV. Didn't really hurt anything but we verified that the needle was in the AC and the patient was fully conscious. Not sure why he was mainlining the d50 though but I can definately see the D50 being mainlined and the entire amount being injected into the tissue rather than the vein.

I don't recommend it except for extreme circumstances.

[mobey]

Actually Mobey, I witnessed a physician giving an amp of d50 via a AC injection minus the IV.........

Maybe I am missing your point.

The poster asked why services would be against Mainlining drugs, and I gave a reasonable justification.

Are you stating now, in contradiction to me, that mainlining IS an administration technique that should be acceptable in EMS based off your anecdotal one time experience?

I would excuse myself from the room in any level of provider was to try mainline a drug that can cause tissue necrosis.

[Just Plain Ruff]

Maybe I am missing your point.

The poster asked why services would be against Mainlining drugs, and I gave a reasonable justification.

Are you stating now, in contradiction to me, that mainlining IS an administration technique that should be acceptable in EMS based off your anecdotal one time experience?

I would excuse myself from the room in any level of provider was to try mainline a drug that can cause tissue necrosis.

no no thats not what I'm advocating at all. I simply was stating the witness to one drug being done that way. I too would be cringing in my boots as well as saying "are you really sure you want to do that" to the doctor even.

The patient was very stable and there was no reason to believe the patient would jerk or pull back thus jeopardizing the needle into the vein patency.

I was really really nervous watching it though.

I also do NOT recommend mainlining D50 at any time no matter the circumstances but I was in no position to contradict the doctor. I expressed my concern and he said "i've done this quite a few times and I know what i'm doing"

in the end it all turned out ok but I knew the risk just as you know them.

Again, I am NOT advocating administering any medication mainline in EMS that might cause tissue necrosis. I hope my position is more clear now.

I'm also not advocating the mainlining of these types of drugs under any circumstances.

[paramedicmike]

DFIB,

There were several reasons provided for why mainlining wasn't allowed. The first centered around the inability to tell if you had infiltrated until it was too late. The second dealt with a potential adverse reaction to the medication meaning stop and put an IV in anyway in an effort to treat the reaction. The third was the safety factor involved in terms of trying to inject a medication while holding the needle in place in the vein. (Seriously, can you imagine trying to inject an entire amp of D50 into someone's arm without an IV in place? I know Ruff watched it. But there's a lot of potential to do some harm there.)

As for why it was illegal? Unfortunately, I don't have an answer to that. I'm sure I asked why at the time. But this was many years ago and I just don't remember. Nor have I been able to find an answer in the few minutes I've had after getting home.

All that being said do some people still mainline drugs to their patients? I'm sure they do. I know they do. But it isn't widely done for the reasons I mentioned above and for the reasons Mobey mentioned.

This probably isn't the definitive answer you were looking for. But I hope it helps anyway.

[tcripp]

Mainlining drugs as an option? Definitely NOT being taught in school.